The U.S. needs a health-care revolution now

The U.S. system is a ‘body shop’ that aims to protect profits

This is the first in a two-part series that profiles Dr. Walter Bortz, an 81-year-old geriatrician, professor, author — and marathon runner. Coming Tuesday: Bortz’s strategies for living 100 healthy years.

Health care needs a total revolution so it starts promoting and paying for health instead of disease. That’s the conclusion Dr. Walter Bortz has come to after writing 150 scientific articles, authoring seven books and spending 40 years as a geriatrician at the Palo Alto Medical Clinic. He is a Stanford University professor of medicine who at age 81 still runs multiple miles three times a week and keeps a rigorous travel and speaking schedule.

Dr. Walter Bortz.

In his new book “Next Medicine,” Bortz argues that health care in the U.S. has become a “body shop” so focused on protecting the profitable status quo that it’s all but turned its back on protecting public health through disease prevention. His diagnosis of modern medicine isn’t pretty.

“It’s expensive, it’s unfair, it’s dangerous, it’s corrupt, it’s inefficient. But the big one is it’s irrelevant,” he told an audience at the University of California-San Francisco in September.

“My profession wants you to be sick for one reason: We can send you a bill.”

Nothing against capitalism, he says. “It’s central to our economy, but it’s got to sell the right product.”

His candor can raise hackles, and he’s not shy about courting controversy. He uses the word “fat,” for example, when describing the obesity problem that increasingly harms children as well as adults.

He questions the head of his own institution about whether the planned $3 billion expansion of Stanford’s hospital facilities includes any funds aimed at keeping people from needing its services. Some critics accuse him of being unrealistic, but he’s flexing a rare muscle in the medical world these days: courage.

“The revolution has to go to prevention from repair,” he told me in a recent interview. “The body-shop gang is not going to like it if you don’t bring your car in. Their country club memberships depend on it.”

Almost everyone can live to 100

Automotive metaphors figure prominently in his work. He advises people to think of four major determinants when considering their long-term health: design, accidents, maintenance and age. While he acknowledges that some high-tech medicine is necessary, Bortz argues that very little of U.S. health spending, which now totals 17% of gross domestic product, goes where it could be most productive.

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“Ninety-five percent of our $2.8 trillion is [spent on] body work,” he says, noting that virtually none of it goes to good health maintenance.

I met with Dr. Bortz on Stanford’s campus on a beautiful late October day. He drove up in a sporty green Mazda Miata; he radiated both cheer and seriousness of purpose. If there is a rock star of geriatric fitness and health promotion, he’s it and he knows it.

Two recent events have alternately saddened and galvanized him: the death of his friend and longtime patient John McCarthy, the eminent computer scientist and artificial-intelligence pioneer, at age 84, and the victory of Fauja Singh, the first 100-year-old marathon runner to cross the finish line, in Toronto.

Bortz expects to have another 19 healthy years ahead of him, and he has long said it’s biologically possible for everyone to become centenarians without major ill health or disability. It requires both guts and smarts, he told the UCSF audience with a smile. But the growing incidence of chronic diseases threatens to undermine the big longevity gains achieved in the last century.

“The threat to the world is chronic disease,” he says, pointing to hundreds of millions of diabetic patients in China and India, among other places. “It’s going to bring the world to its knees, and we can’t afford it.”

The number of people with diabetes had doubled worldwide to 347 million in 2008, from 153 million in 1980, according to a study published June 25 in the Lancet.

A national ‘health-care spending’ clock

Bortz is working with corporate and other leaders to help people steer clear of serious ills such as obesity and diabetes. Among his ideas: a national health-care spending board akin to the national debt clock where people could see how the number of steps they take per day can reduce the collective financial burden. A fitness blood test that could be used to charge people less on their health insurance if they stay fit. And preventive orthopedics that could help people identify and correct joint and muscle-strength problems before they degenerate into arthritis.

Medicine’s mission, he says, should be the assertion and assurance of human potential. Bortz argues that after an era when infections were the primary killers, the tools in the modern tool kit — surgery and drugs — are mostly outdated to treat the kinds of behavior-born threats we now face.

Knowledge of what it takes to preserve health is now at a tipping point, he says, making it incumbent upon people who understand the basic science to teach and encourage those who don’t.

Bortz isn’t alone in sounding the alarm about chronic disease. Addressing it is key to national solvency, says Ken Thorpe, a health-policy professor at Emory University in Atlanta and executive director of the Partnership to Fight Chronic Disease, a nonprofit coalition of more than 100 organizations that focus on prevention and chronic-disease management.

Lawmakers need to figure out how to reduce or slow the growth of the share of patients with chronic disease “if they’re going to deal with entitlement spending,” Thorpe told me last summer as the debt-ceiling debate raged in Congress. “We need to reorganize how care is provided and managed and we also need to do a better job of keeping incoming patients to the Medicare program healthier.”

Exercise acts as armor

An only child, Walter M. Bortz II grew up in a row house in Philadelphia. He had regular contact with intellectual luminaries such as Linus Pauling, a two-time Nobel Prize winner, and Frederick Banting, one of the Canadians who discovered insulin. He recalls the way his father, an internist, would regularly accept barter such as oil paintings as payment for his medical services. The senior Bortz was president of the American Medical Association in 1947.

The father-son bond was a defining one. It’s part of what drove the younger Bortz to complete a marathon every year for the last 41 years.

“I picked it up when I was 39 and my father died,” he says. “It was very much a grief reaction. I was smart enough to know running was the best therapy for depression.”

Decades later, he’s still running, albeit at a slow pace. He completed the San Francisco marathon this year and plans to go to Ferrara, Italy, to run his 42nd marathon in 2012.

His habit serves a biological purpose, he says, noting that exercising is like acquiring “armor” against the risk of disease. “As I’m running, I’m conjuring up my genes to be properly expressed.”

Bortz’s physical and intellectual discipline can be intimidating, but he has a few indulgences, too. He drinks beer and wine every night and loves ice cream, though he limits himself to once a week. He enjoys Stanford football and has a rich family life with his wife, also an accomplished marathon runner, four adult kids and nine grandchildren.

His thinking on health policy has changed significantly over the years. He supports Obama’s health-reform law, saying universal health insurance is a must, but he cautions against covering too many services. Of concern is the potential to overuse MRIs, stents and other big-ticket items while shortchanging prevention.

Bortz opposed the Medicare prescription-drug benefit that Congress approved in 2003. “Old people don’t need more pills,” he says. “They need to take a walk.”

The drug benefit, he wrote in his book, “is destined to cost future taxpayers trillions of dollars, and the principal beneficiaries will be the stockholders of Merck, Pfizer and the other drug companies.”

Bortz favors the collective personal responsibility that he found more in evidence when he traveled outside U.S. borders.

“Australia is ahead of us,” he says. “They’re more socialistic. They do more for other people than we do here.”

He’s unfazed by criticism that his proposals to upend health care as we know it are unworkable. “I’d much rather be right and be proven so eventually than concede to the pragmatics of corporate greed.”

In contemplating mortality, Bortz cites Irvin Yalom’s book “Staring at the Sun,” and says that after death, human energy may remain as ripples.

He turns humble at the thought.

“My dad is my reference point. He was a great man,” Bortz says. “Every time I think I have a certain competence, I say he had it before me. I’m just kind of playing out his ripples.”

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